Correct as at 5/08/2022
Ministry of Health Monkeypox case definition update Clinical presentation Monkeypox (MPX) classically presents with a prodrome with fever, aches and lymphadenopathy, followed by a characteristic centrifugal rash with the lesions first appearing on the face and moving to distal extremities. The rash also progresses through four stages simultaneously from macules to papules, vesicles then pustules, followed by scabbing. In the 2022 outbreak, presentations of monkeypox have been atypical: • • • •
The rash/lesions may be localised to ano-genital skin, or oropharynx or rectal mucosa (proctitis) There may be a solitary lesion The rash/lesions may not necessarily progress through four stages as described above Systemic symptoms may be absent or have developed after the onset of rash.
The clinical presentation is similar to diseases that are more commonly encountered in clinical practice, such as hand foot and mouth disease, varicella zoster, herpes simplex, syphilis and molluscum contagiosum. As a result, more common causes of acute rashes with similar appearances should be considered and excluded where possible. However, co-infections have occurred sporadically, and given the evolving epidemiology of monkeypox, patients with a rash suggestive of monkeypox should be considered for testing, even if other conditions are likely.
Clinical and epidemiological criteria
Clinical criteria A clinically compatible illness characterised by the presence of acute unexplained1 skin and/or mucosal lesions or proctitis (for example anorectal pain, bleeding) and
Epidemiological criteria At least one of the following: • exposure2 to a confirmed or probable case in the 21 days before symptom onset • history of travel to West or Central Africa where MPX is endemic in the 21 days before symptom onset • is a priority group for testing. At this time, priority groups for testing include the following:
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More common causes of acute rashes with similar appearances should be considered and excluded where possible; varicella zoster, herpes simplex, syphilis, molluscum contagiosum. 2 Exposure: direct physical contact with skin or skin lesions, including sexual contact; or contact with contaminated materials such as clothing, bedding or utensils; or prolonged face-to-face contact, including health care workers without appropriate PPE
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